Outpatient wound care and Hyperbaric Center

1. OUTPATIENT WOUND CARE AND
HYPERBARIC CENTER

2. PATIENT POPULATION
• Adult patients only
• 90% of patients 60 yo and above
• 50% CVI
• 30% DFU
• +300 visits/month

3. STAFF
• 9 MDs
• 1 Vascular surgeon , 1 Podiatrist, 1 Rehab, 6 IM
• All MDs (except Podiatrist) are Hyperbaric oxygen therapy certified
• 5 RNs
• All RNs are HBO certified
• 1 HBO Tech (CNA)
• 1 office staff

4. BASELINE ASSESSMENT
• VENOUS INSUFFICIENCY
• Venous Dopplers
• ABIs (for compression therapy)
• Tissue cultures/Biopsy
• Nutrition markers
• ADLs
• DIABETIC ULCERS
• Toe pressures
• A1C
• Tissue cultures/Biopsy
• Imaging (x rays, MRIs, CT, Bone scans,
etc. )
• Nutritional markers
• Offloading footwear
• ADLs

5. BASELINE ASSESSMENT
• PRESSURE ULCER/INJURIES
• Tissue cultures/Biopsy
• Nutritional markers
• Imaging (x rays, MRIs, CT, bone scans,
etc. )
• Surfaces
• Co-morbidities
• Vascular tests (lower extremities)
• ARTERIAL ULCER
• ABIs
• Arterial doppler
• Nutritional markers
• Surgery candidate?

6. WOUND CARE CENTER
WHEN TO REFER?
• 4 weeks of failure to respond to standard wound
care.
• Atypical wounds

7. WOUND MANAGEMENT
• Serial debridement
• Negative Pressure Wound Therapy
• Skin grafting (autograft and allograft)
• Biosynthetic skin substitutes and
wound matrices.
• Compression therapy
• Electrical stimulation
• Ultrasonic mist therapy
• PRP (Platelet rich plasma) therapy
• Total contact casting
• Surgical interventions
• Hyperbaric oxygen therapy (HBOT)

8. HYPERBARIC OXYGEN THERAPY (HBOT)
• Inhalation of 100% oxygen in a total body chamber where the atmospheric pressure is
increased and controlled.
• Initially used to manage decompression sickness. Primary usage in the US is for
wound care.
• 4 Functions of HBOT.
• 1) Increases the concentration of dissolved oxygen in the blood thereby enhancing
perfusion.
• 2) It stimulates the formation of collagen, encouraging angiogenesis
• 3) Replaces inert gas in the blood stream with oxygen
• 4) Bactericidal properties.

9. HYPERBARIC OXYGEN THERAPY (HBOT)
MONO PLACE CHAMBER

10. HYPERBARIC OXYGEN THERAPY (HBOT)
MULTI PLACE CHAMBER

11. HYPERBARIC OXYGEN THERAPY (HBOT)
MEDICARE APPROVED DX
• Acute carbon monoxide poisoning
• Decompression illness
• Gas embolism
• Gas gangrene
• Progressive necrotizing infections
• Crush injuries and suturing of severed limbs
• Acute traumatic peripheral ischemia
• Acute peripheral arterial insufficiency
• Preparation and preservation of compromised skin graft
• Chronic refractory osteomyelitis
• Diabetic wounds of the lower extremities
• Osteoradionecrosis * (as adjunct to conventional treatment)
• Soft tissue radionecrosis *
• Actinomycosis (refractory) *
• Cyanide poisoning
• Intracranial abscess** (Undersea and Hyperbaric Medical Society)
• Acute thermal burn**
• Idiopathic sudden sensorineural hearing loss**

12. HYPERBARIC OXYGEN THERAPY (HBOT)
GUIDELINES FOR COVERAGE
•No measurable signs of healing for 30
consecutive days of standard wound therapy.
•Must be used in addition to standard wound
care.

13. HBOT MEDICARE GUIDELINES
DIABETIC WOUNDS OF THE LOWER EXTREMITIES
• Type 1 or 2 DM, wounds should be caused by diabetes
• Wagner grade III or higher

14. HBOT MEDICARE GUIDELINES
CHRONIC REFRACTORY OSTEOMYELITIS
• Initial radiographic or biopsy dx of osteomyelitis
• 6 weeks of antibiotic therapy
• Surgical notes if available
• Radiographic or biopsy confirmation of the refractory osteomyelitis
• HBOT should be used as adjunctive therapy

15. QUESTIONS